title: Lower limb lymphedema in gynecological cancer survivors--effect on daily life functioning.
abstract: OBJECTIVE
  Lower limb lymphedema (LLL) is a common condition after pelvic cancer treatment but few studies have evaluated its effect on the quality of life and its consequences on daily life activities among gynecological cancer survivors.
  
  
  METHODS
  We identified a cohort of 789 eligible women, treated with pelvic radiotherapy alone or as part of combined treatment of gynecological cancer, from 1991 to 2003 at two departments of gynecological oncology in Sweden. As a preparatory study, we conducted in-depth interviews with gynecological cancer survivors and constructed a study-specific questionnaire which we validated face-to-face. The questionnaire covered physical symptoms originating in the pelvis, demographic, psychological, and quality of life factors. In relation to the lymph system, 19 questions were asked.
  
  
  RESULTS
  Six hundred sixteen (78 %) gynecological cancer survivors answered the questionnaire and participated in the study. Thirty-six percent (218/606) of the cancer survivors reported LLL. Overall quality of life was significantly lower among cancer survivors with LLL. They were also less satisfied with their sleep, more worried about recurrence of cancer, and more likely to interpret symptoms from the body as recurrence. Cancer survivors reported that LLL kept them from physical activity (45 %) and house work (29 %) and affected their ability to partake in social activities (27 %) or to meet friends (20 %).
  
  
  CONCLUSIONS
  Lower limb lymphedema has a negative impact on quality of life among gynecological cancer survivors, affecting sleep and daily life activities, yet only a few seek professional help.
authors.affiliation: Clinical Cancer Epidemiology, Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Gail
authors.initials: G
authors.lastname: Dunberger
authors.forename: Helene
authors.initials: H
authors.lastname: Lindquist
authors.forename: Ann-Charlotte
authors.initials: AC
authors.lastname: Waldenström
authors.forename: Tommy
authors.initials: T
authors.lastname: Nyberg
authors.forename: Gunnar
authors.initials: G
authors.lastname: Steineck
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Åvall-Lundqvist
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D001007:Anxiety / Q000523:psychology; D005260:Female; D005833:Genital Neoplasms, Female / Q000150:complications / Q000523:psychology* / Q000532:radiotherapy*; D006801:Humans; D035002:Lower Extremity; D008209:Lymphedema / Q000209:etiology* / Q000523:psychology*; D008875:Middle Aged; D010386:Pelvic Neoplasms / Q000150:complications / Q000523:psychology / Q000532:radiotherapy; D011788:Quality of Life; D011878:Radiotherapy / Q000009:adverse effects* / Q000523:psychology; D012893:Sleep Wake Disorders / Q000209:etiology / Q000523:psychology; D011795:Surveys and Questionnaires / Q000592:standards; D017741:Survivors / Q000523:psychology*; D013548:Sweden